TNF and metabolic dysfunction-associated steatotic liver disease: At 4 years of follow-up, the cumulative incidence of NAFLD was 29.2% (106/363). Those who developed NAFLD had higher serum TNF-α levels than those who did not (mean 3.65 vs. 3.15 pg/ml; P < 0.01). The incidence of NAFLD increased significantly with increasing TNF-α tertiles (22.6, 35.8, and 41.5%, for the first, second, and third tertiles, respectively; P < 0.05). The risk of developing NAFLD was significantly higher in the highest tertile of TNF-α than in the lowest (OR, 2.20; P < 0.05)